Provider Relations Advocate - Remote in Massachusetts

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs — helping patients access and navigate care anytime and anywhere. As a team member of our Senior Community Care (SCC) team, we work to provide care to patients in nursing homes, senior housing and assisted living settings. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.

The more you do, the more you learn. As you learn, you'll discover new opportunities to grow, make an impact, and bring your best every day. As a Provider Relations Advocate with UnitedHealth Group, you'll play a critical role in strengthening provider partnerships and improving the health care experience for providers and members alike.

We're building solider, more effective provider networks every day. In this role, you'll serve as a trusted resource and advocate for providers, using your customer service skills, managed care knowledge, and claims expertise to help resolve issues and improve the provider experience. You'll have the opportunity to deepen your understanding of provider relations, network operations, claims processes, and health plan administration while gaining exposure to a broad range of business partners and functions across the organization.

What Makes This Role Unique
This individual contributor role is ideal for early to mid-career professionals seeking to advance their careers within provider relations and managed care. The ideal candidate brings experience working with skilled nursing facilities or long-term care providers and possesses a solid understanding of MassHealth policies, including billing, authorization, and regulatory processes.

If you are located within Massachusetts, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

• Serve as a trusted resource to skilled nursing facilities and long-term care providers, helping navigate claims, billing, authorization, and operational processes
• Experience working directly in a skilled nursing facility, nursing facility, or long-term care environment and possess a solid understanding of Massachusetts Senior Care Options (SCO), including Medicare and MassHealth (Medicaid) policies and regulations
• Experience with facility billing, prior authorization workflows, claims management, reimbursement processes, and nursing facility regulations is highly desired
• The successful candidate will understand the day-to-day operational needs of nursing facilities and be able to build solid provider relationships while supporting issue resolution and provider education initiatives

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:  

• High school diploma/GED or equivalent experience
• 1 years of experience working within a Skilled Nursing Facility (SNF), Nursing Facility, Long-Term Care (LTC), post-acute care setting, or other provider organization serving senior populations
• 1 years of experience supporting provider operations, provider relations, billing, reimbursement, admissions, utilization review, authorization, care coordination, or related functions
• Proven working knowledge of Massachusetts Senior Care Options (SCO) and the coordination of Medicare and MassHealth (Medicaid) benefits
• Experience collaborating with facility leadership, business office staff, billing teams, clinical staff, and external stakeholders
• Intermediate proficiency with Microsoft Office
• Driver’s License and access to reliable transportation

Preferred Qualifications:  

• 3 years of experience working within a Skilled Nursing Facility (SNF), Nursing Facility, Long-Term Care (LTC), post-acute care setting, or other provider organization serving senior populations
• 3 years of experience supporting provider operations, provider relations, billing, reimbursement, admissions, utilization review, authorization, care coordination, or related functions
• Experience with Medicare and Medicaid programs, including claims, billing, reimbursement, eligibility, prior authorization, and issue resolution
• Solid understanding of claims adjudication, reimbursement methodologies, provider appeals, and payment resolution processes
• Knowledge of provider contracting, credentialing, and network development functions
• Experience analyzing provider trends and recommending operational improvements

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.